Roentgenologic Observations in Addison's Disease

Publisher Website
Google Scholar
Abstract
During recent years remarkable progress has been achieved in the diagnosis and treatment of adrenal insufficiency. The availability of potent and highly purified preparations of the adrenocorticotropic hormone (acth) has resulted in the development of improved diagnostic procedures for the evaluation of adrenocortical function. The isolation, synthesis and large scale production of individual adrenal cortical steroids which are highly effective in replacement therapy have greatly altered the prognosis of a disease once considered almost hopeless. As a consequence of these advances, an ever increasing number of patients with chronic adrenal cortical insufficiency are being successfully maintained in an active and productive state. In the overall clinical management of these patients, roentgen examination may play an important role. It is the purpose of this report to summarize the results of roentgenologic observations made during the past twenty years in patients with Addison's disease observed at the Peter Bent Brigham Hospital. Methods This study is based on the roentgenologic examinations of 120 patients. The following criteria have been employed for inclusion in this series: (a) History: Although the symptoms of Addison's disease are often non-specific, certain manifestations are almost constantly present: fatigability, muscular weakness, weight loss, anorexia, and gastrointestinal symptoms. (b) Physical Examination: Hypotension is an almost invariable finding in untreated patients. Characteristic pigmentation of the skin and mucous membranes is found with such great regularity that its absence casts considerable doubt upon the diagnosis. (c) Laboratory Findings: Hyponatremia, hyperkalemia and azotemia are commonly encountered in untreated patients, especially those in whom the disease is of long duration or in whom adrenal crisis may be imminent. It is to be emphasized, however, that in many instances these values are normal. Electroencephalographic changes are highly suggestive of Addison's disease, although an abnormally slow pattern may be encountered in situations other than adrenal insufficiency (e.g., myxedema). (d) Special Tests: All patients admitted since 1947 have undergone vigorous testing with adrenocorticotropic hormone, (acth). In normal subjects, stimulation of the adrenal cortex by acth produces numerous metabolic and cytologic changes, of which a fall in circulating eosinophils and a rise in urinary steroid excretion serve as convenient and accurate indices of adrenal cortical activation (1). Since patients with Addison's disease fail to exhibit these characteristic responses, the acth test provides a highly specific and reliable means of establishing or confirming the diagnosis of adrenal insufficiency.

This publication has 0 references indexed in Scilit: